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CC BY 4.0 · Endosc Int Open 2025; 13: a26763883
DOI: 10.1055/a-2676-3883
Original article

Post-endoscopy esophageal adenocarcinoma and root cause analysis in Auckland, New Zealand

Authors

  • Seong Shin

    1   Gastroenterology, Te Whatu Ora Health New Zealand Waitemata, Auckland, New Zealand (Ringgold ID: RIN1406)

  • Dongyeon Kang

    1   Gastroenterology, Te Whatu Ora Health New Zealand Waitemata, Auckland, New Zealand (Ringgold ID: RIN1406)

  • Russell S Walmsley

    2   Gastroenterology, North Shore Hospital, Auckland, New Zealand (Ringgold ID: RIN1403)
    3   Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand (Ringgold ID: RIN62710)
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Abstract

Background and study aims

Post-endoscopy esophageal adenocarcinomas (PEEC) challenge timely diagnosis of esophageal adenocarcinomas (OAs). This study aimed to determine prevalence of PEECs in Auckland region and elucidate the most plausible causes through a root-cause analysis framework.

Patients and methods

OA cases diagnosed in Auckland from 2013 to 2022 were retrieved from the New Zealand Cancer Registry (NZCR). Electronic clinical data were collected via the Regional Clinical Portal software. The primary outcome was PEEC prevalence, defined as OA diagnosed 6 to 36 months following an esophagogastroduodenoscopy (EGD) that failed to detect the cancer. Identified PEECs were classified into six categories.

Results

Among 633 OA cases, 45 (7.1%) were PEECs. A higher prevalence of PEEC was observed in patients with Barrett’s esophagus (BE) (18.1% vs 2.7%), undergoing surveillance EGDs (52.6% vs 3.6%) and with early-stage cancers. Root-cause analysis delineated the PEEC causes, classified as follows: A (17.8%): lesion was identified, endoscopic assessment was adequate, follow-up was appropriately planned and executed, yet PEEC developed; B (17.8%): follow-up was delayed due to administrative factors; C (22.2%): follow-up decisions were inappropriate; D (22.2%): inadequate endoscopic assessment; E (11.1%): lesion was unidentified despite adequate assessment; and F (8.9%): lesion was unidentified and assessment was inadequate. Categories B, C, D, and F comprised 71.1% of cases deemed potentially avoidable.

Conclusions

Auckland’s PEEC prevalence aligns with international post-endoscopy upper gastrointestinal cancer rates. Root-cause analysis underscores that a significant proportion of PEECs may be preventable with improved clinical practice.

Keywords

Endoscopy Upper GI Tract - Barrett's and adenocarcinoma - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Malignant strictures


Publication History

Received: 06 January 2025

Accepted after revision: 31 July 2025

Accepted Manuscript online:
04 August 2025

Article published online:
30 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Seong Shin, Dongyeon Kang, Russell S Walmsley. Post-endoscopy esophageal adenocarcinoma and root cause analysis in Auckland, New Zealand. Endosc Int Open 2025; 13: a26763883.
DOI: 10.1055/a-2676-3883
 

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